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Original Investigation | Clinical Sciences

Graft Adhesion in Descemet Membrane Endothelial Keratoplasty Dependent on Size of Removal of Host’s Descemet Membrane

Theofilos Tourtas, MD1; Juliane Schlomberg, MD1; Julia M. Wessel, MD1; Bjoern O. Bachmann, MD1; Ursula Schlötzer-Schrehardt, PhD1; Friedrich E. Kruse, MD1
[+] Author Affiliations
1Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
JAMA Ophthalmol. 2014;132(2):155-161. doi:10.1001/jamaophthalmol.2013.6222.
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Importance  It is essential to devise strategies that improve graft adhesion after Descemet membrane endothelial keratoplasty (DMEK) to reduce the rebubbling rate.

Objective  To evaluate the influence of the extent of descemetorhexis on graft adhesion properties after DMEK.

Design, Setting, and Participants  Single-surgeon, retrospective, observational case series conducted in the Department of Ophthalmology, University of Erlangen-Nuremberg, Germany, that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host’s Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host’s Descemet membrane.

Main Outcomes and Measures  Graft detachment rate, extent of graft detachment (in clock hours of graft’s circumference), and rebubbling rate.

Results  Four days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03).

Conclusions and Relevance  A larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.

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Figures

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Figure 1.
Extent of Descemetorhexis

Schematic image shows the position of the graft and the margin of the host’s Descemet membrane after Descemet membrane endothelial keratoplasty (DMEK) in eyes with larger (group A [A]) and smaller (group B [B]) descemetorhexis. There are 3 small trephine marks at the edge of the graft to ensure correct graft orientation during surgery; slitlamp image at day 8 after DMEK shows the peripheral zone of denuded stroma between the graft and host’s Descemet membrane in eyes with larger descemetorhexis (group A [C]) and the peripheral zone of overlapping between the graft and host’s Descemet membrane in eyes with smaller descemetorhexis (group B [D]).

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Figure 2.
Graft Detachment Rate

Graft detachment rate at day 4 after Descemet membrane endothelial keratoplasty in eyes with larger (group A) and smaller (group B) descemetorhexis.

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Figure 3.
Extent of Graft Detachment

Extent of graft detachment (in clock hours) at day 4 after Descemet membrane endothelial keratoplasty in eyes with larger (group A) and smaller (group B) descemetorhexis. Circle indicates a case with more than 1.5 box lengths from the upper or lower edge of the box; s, significant (P < .001, Mann-Whitney test).

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Figure 4.
Localization of Graft Detachment

Localization of graft detachment at day 4 after Descemet membrane endothelial keratoplasty in eyes with larger (group A) and smaller (group B) descemetorhexis.

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Figure 5.
Rebubbling Rate

Rebubbling rate after Descemet membrane endothelial keratoplasty in eyes with larger (group A) and smaller (group B) descemetorhexis.

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